Management of the patient with cardiovascular cisease

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Management of the Patient with Cardiovascular Disease

Diagnosis

The patient exhibits poorly controlled hypertension, given that his/her blood pressure is 166/94 mmHg while on 5 mg of amlodipine daily. Moreover, the patient has hyperlipidemia, LDL, which is 142 mg/dL, and total cholesterol, which is 210 mg/dL, putting him at risk for developing atherosclerotic cardiovascular disease (ASCVD). This patient has developed lower extremity edema while on amlodipine, which may be related to the use of the drug; however, it is moderate in severity and thus does not warrant discontinuation of the drug at the current time. As the patient weighed 220 pounds and stood 70 inches tall, he falls under the ‘obese’ category, a factor that increases his chances of developing hypertension and cardiovascular diseases. It is, therefore, crucial for him to adopt appropriate adjustments in diet and exercise to tackle his obesity and related predisposing factors of cardiovascular diseases.

Medication Management and Rationale

The patient continues to have uncontrolled hypertension while on amlodipine 5 mg a day. Thus, an ACE lisinopril should be added to improve blood pressure control and reduce cardiovascular risk. ACE inhibitors have been reported to be effective when integrated with calcium channel blockers in black patients, as outlined in Whelton et al. (2018). As the patient has hyperlipidemia with an LDL of 142mg/dL, a statin needs to be started to prevent atherosclerosis and cardiovascular events (Grundy et al., 2019). The mild lower extremity edema is a side effect of amlodipine; nonetheless, since it is traced, the benefit is more important than the risk, and thus, he should continue taking the medication. If the edema worsens, switching to another antihypertensive agent may be considered.

Prescription Plan:

1. Lisinopril 10 mg PO once daily– This ACE inhibitor helps lower blood pressure and provides renal protection. Monitor for hyperkalemia and angioedema.
2. Atorvastatin 20 mg PO once daily at bedtimelowers LDL and total cholesterol, reducing cardiovascular risk. Educate the patient on potential muscle pain and liver function monitoring.
3. Amlodipine 5 mg PO once daily– Continue as it provides effective BP control with minimal side effects.

Patient Education

The patient should be advised on the need to stay compliant with his medications regarding his hypertension and cholesterol status. He should make arrangements to check his blood pressure at home, and any signs or symptoms like weakness, excessive coughing, or swelling of the limbs should be reported early. To manage his blood pressure and weight, dietary changes such as limiting the use of salt, increasing fiber intake, and adopting a diet recommended for heart diseases, such as the DASH diet. Recommended physical activity levels include 150 minutes per week of moderate intensity for weight loss and improving cardiovascular health. Sensible drinking, watching the amount of caffeine taken, and avoiding tobacco use are the other factors that should be avoided to prevent cardiovascular disease. The patient should be informed that when taking certain medicines, there might be side effects such as muscle pain when taking statins or even a dry cough when taking lisinopril, among others, and should talk to the doctor if they experience any signs or symptoms.

Follow-up Plan

• Reassess BP and lipid panel in 4 weeks to evaluate response.
• Monitor kidney function and electrolytes after initiating lisinopril.
• Consider cardiology referral if BP remains uncontrolled despite adjustments.

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